Fibromuscular Dysplasia of the Renal Artery

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     During a routine preoperative checkup before a planned hysterectomy, a healthy 31-year-old woman was noted to have an elevated blood pressure of 230/130 mm Hg, mild headache without chest pain, shortness of breath, and proteinuria. Her serum creatinine level was 1.0 mg per deciliter (88 μmol per liter; normal range, 0.5 to 0.9 mg per deciliter ), and an electrocardiogram showed signs of left ventricular hypertrophy. Antihypertensive treatment with 20 mg of enalapril per day and 100 mg of metoprolol per day was started and led to a drop in blood pressure to 120/75 mm Hg. Screening for secondary causes of hypertension revealed a normal thyrotropin level; a normal cortisol level, measured after an overnight fast; a normal androstenedione level; and normal 24-hour urinary excretion of catecholamines; however, angiographic computed tomography (CT) revealed a collateralized, subtotal stenosis of the distal left renal artery with a small, poststenotic aneurysm (arrow, Panel A), which was diagnostic of fibromuscular dysplasia. The size of the left kidney was normal (10 by 5 cm). There was no history of trauma to the left kidney. To preserve kidney function, surgical revascularization was favored because of the distal location and complex morphologic characteristics of the stenosis and the poststenotic aneurysm. Repair of the left renal artery with an autogenous saphenous-vein aortorenal graft was performed. Histologic examination of the resected artery revealed fibromuscular dysplasia. The patient's blood pressure normalized immediately after surgery, with no further need for antihypertensive medication. Angiographic CT at the 2-month follow-up visit showed a patent left renal artery without restenosis (arrow, Panel B).

    Christoph Caliezi, M.D.

    Peter Reber, M.D.

    Lindenhofspital

    Bern 3001, Switzerland

    christoph.caliezi@lindenhofspital.ch

    http://www.100md.com/html/DirDu/2007/01/16/34/25/54.htm